JP4643246B2 - Laparoscopic surgical system - Google Patents

Description

The present invention relates to a laparoscopic surgical system comprising a gas supply apparatus capable of supplying gas to the laparoscope observing the endoscopic Kagami及 beauty intraperitoneally to be inserted into the lumen.

  In order to reduce the invasion to a patient, a laparoscopic surgical operation (hereinafter, also referred to as a surgical operation) for performing a therapeutic procedure without performing a laparotomy is performed. In this surgical operation, for example, a first trocar for guiding an observation endoscope (also referred to as a laparoscope) into a body cavity and a second trocar for guiding a treatment tool to a treatment site are provided on the patient's abdomen. Is punctured.

  Then, for the purpose of ensuring the field of view of the endoscope and the area for operating the treatment tool, the gas for insufflation is injected into the abdominal cavity through the trocar or another trocar. As a result, the abdominal cavity is inflated, and the endoscope inserted into the abdominal cavity through the first trocar allows observation of the treatment site and the treatment instrument inserted through the second trocar. Treatment can be performed while performing. For example, carbon dioxide gas that is easily absorbed by a living body (hereinafter referred to as carbon dioxide gas) is used as the gas for insufflation.

  In the insufflation apparatus, a state in which carbon dioxide gas flows through the air supply conduit and a state in which the flow of carbon dioxide through the air supply conduit is interrupted are repeated. The control unit detects the pressure in the abdominal cavity using a pressure sensor, compares and monitors the difference between the preset abdominal pressure of the patient and the actual abdominal pressure, and adjusts the flow rate according to the difference. To do.

  In recent years, as a new attempt, in addition to the endoscope inserted into the abdominal cavity through the first trocar, the treatment site is treated by inserting an insertion portion of the endoscope into a lumen such as the large intestine. The procedure to do is performed. In this technique, treatment can be performed by specifying a treatment site using an abdominal endoscope and a lumen endoscope.

  FIG. 11 shows a configuration of a laparoscopic surgical system for performing a procedure for treating a treatment site by inserting an insertion portion of an endoscope into a lumen of a large intestine or the like in addition to an endoscope inserted into the abdominal cavity. It is a figure explaining an example.

  When performing the procedure, for example, as shown in FIG. 11, a first light source device 101 and a first camera control unit 103 connected to an endoscope (not shown) inserted on the abdominal cavity side through a trocar, a lumen A second light source device 102 and a second camera control unit 104 which are connected to an endoscope (not shown) having an insertion portion inserted into the pneumograph, an insufflation device 105 for supplying carbon dioxide gas into the abdominal cavity via a trocar, Endoscopic CO2 Regulator: Endoscopic CO2 Regulator: supplying carbon dioxide gas into the lumen via the first carbon dioxide cylinder 107 and an air / water supply pipe provided in the insertion portion of the endoscope (Hereinafter abbreviated as ECR) 106 and a second carbon dioxide gas cylinder 108, and a system component that is electrically connected to each of the devices 101, 102, 103, 104, 105, and 106 to perform operation control. In addition to the roller 110 or the like, for example, ablation device (also referred to as an electric knife) constituting a laparoscopic surgical system 100 is provided treatment apparatus 111, and the like. By configuring the laparoscopic surgical system 100, carbon dioxide gas can be supplied into the abdominal cavity by the pneumoperitoneum apparatus 105, and treatment can be performed by supplying carbon dioxide gas into the lumen by the ECR 106. Each device is disposed in the first cart 112, the second cart 113, the ECR cart 114, and the like.

  In the ECR 106, the lumen tube 115 extending from the ECR 106 is connected to the second light source device 102 in place of the air supply tube (not shown). As a result, the carbon dioxide gas supplied from the ECR 106 is supplied to the light source connector (not shown) of the endoscope (not shown) connected to the second light source device 102, and the air / water supply pipe. Supplied into the lumen via a channel.

  Reference numerals 116 and 117 are observation monitors on which endoscopic images and the like are displayed. Reference numeral 118 is a central operation panel, reference numeral 119 is a central display panel, reference numerals 121 and 122 are image recording apparatuses, reference numeral 123 is a distributor, Reference numeral 124 is a communication connector, reference numeral 125 is a communication connector, reference numeral 126 is a distributor, reference numeral 127 is a suction bottle, reference numeral 128 is a peripheral device controller, reference numerals 129a and 129b are communication cables, and reference numeral 130 is a connection cable.

  However, in the surgical operation system shown in FIG. 11, a pneumoperitoneum, an ECR, and a gas cylinder corresponding to each device must be installed in the operation room. For this reason, the malfunction that the operating room becomes narrow occurs.

  Further, when performing a procedure using both the pneumoperitoneum and the ECR, since the luminal organ is inside the abdominal cavity, the pressure inside the lumen is affected by the abdominal pressure. Therefore, carbon dioxide must be supplied against the abdominal pressure. In this case, the air / water supply pipe provided in the endoscope inserted on the lumen side has a small diameter and a long pipe length. For this reason, the pipe resistance is large, and the supply pressure must be set to a high pressure in order to ensure the flow rate of carbon dioxide gas. In other words, in the air supply pressure of the insufflation apparatus 105 that supplies carbon dioxide gas into the abdominal cavity via the trocar, sufficient carbon dioxide gas is supplied into the lumen through the air / water supply line provided in the endoscope. It was difficult.

  Furthermore, in the endoscope, an air supply provided in the operation unit of the endoscope is configured so that air supply and water supply can be performed via the air supply / water supply conduit by appropriately operating the air supply / water supply button. -It is configured to constantly leak air from the through hole formed in the water supply button. Therefore, in the configuration in which carbon dioxide gas is supplied into the lumen through the air supply base, the carbon dioxide gas continues to leak from the through hole when the carbon dioxide gas is not supplied into the lumen. Therefore, the malfunction that the carbon dioxide gas in a gas cylinder is consumed wastefully generate | occur | produces.

  The present invention has been made in view of the above circumstances, and provides an endoscope capable of supplying gas into a lumen without setting the supply pressure to a high pressure, and air is fed into the abdominal cavity via a trocar. It is an object of the present invention to provide a laparoscopic surgical system including an air supply device capable of supplying air into a lumen through the endoscope with a normal air supply pressure.

The laparoscopic surgical system of the present invention has a light source connector at one end that can be connected to a light source device at an insertion portion to be inserted into a lumen, and a light guide that transmits illumination light from the light source device. An endoscope in which an operation unit having a universal cord extending therein is extended, and a fluid supply disposed in a portion of the operation unit of the endoscope that is different from the extension portion of the universal cord. And a lumen carbon dioxide gas supply line formed in the insertion portion of the endoscope without being connected to any fluid line in the universal cord and communicating with the fluid supply base. , the insertion portion pneumoperitoneum carbonated gas toward the inside the abdominal cavity through a trocar, which is pierce the abdominal wall according to the different abdominal cavity and the lumen that is inserted in the endoscope to a predetermined air pressure Ri supplies, the air supply device to the luminal cavity carbon dioxide toward the luminal cavity carbon dioxide supply conduit in the endoscope can be supplied by the same air pressure as the predetermined air pressure, the feed A first fluid tube body extending from an air device and connected to the trocar is different from an extension portion of the universal cord in an operation portion of the endoscope extending from the air supply device. A second fluid tube body connected to the fluid supply base disposed in the portion, and the carbon dioxide gas supply conduit for the lumen from the air supply device to the second fluid The air supply pressure relating to the carbon dioxide gas for the lumen supplied to the carbon dioxide gas supply pipe for the lumen via the tube body and the fluid supply base is changed from the air supply device to the first fluid tube body. And against the abdominal cavity via the trocar The luminal carbon dioxide against the abdominal pressure caused by the pneumoperitone carbon dioxide supplied into the abdominal cavity even if the supply pressure is the same as the supply pressure related to the pneumoconiton carbon dioxide supplied It has a pipe line resistance that allows the gas supply pipe line to supply a carbon dioxide gas for lumen having a predetermined flow rate or more .

  According to this configuration, the flow path length of the fluid supply conduit provided in the endoscope for supplying fluid into the lumen is greatly reduced.

  According to the present invention, it is possible to realize an endoscope capable of supplying gas into a lumen without setting a supply pressure at a high pressure. In addition, a laparoscopic surgical system including an air supply device that can supply air into the lumen via the endoscope with air pressure when air is supplied into the abdominal cavity via a trocar can be realized.

Embodiments of the present invention will be described below with reference to the drawings.
1 to 10 relate to an embodiment of the present invention, and FIG. 1 is a diagram illustrating a configuration of a laparoscopic surgical system having first and second endoscope systems and an air supply system. FIG. 3 is a diagram for explaining the configuration of an air supply device, FIG. 4 is a diagram for explaining a panel portion of the air supply device, and FIG. 5 is an air supply device. 6 is a flowchart for explaining an example of air supply control by the control unit, FIG. 6 is a diagram for explaining a hand switch that is detachably attached to the operation unit of the endoscope, and FIG. 7 is an intraluminal air supply control switch for the operation unit. FIG. 8 is a diagram for explaining the operation state of the fluid control button, FIG. 9 is a diagram illustrating another configuration example of a laparoscopic surgical system capable of supplying and sucking air into the lumen. FIG. 10 is a diagram for explaining an endoscope provided with a suction unit in the vicinity of the air / water supply switch of the operation unit. It is a diagram.

  As shown in FIG. 1, a laparoscopic surgical system (hereinafter abbreviated as a surgical system) 1 according to this embodiment includes a first endoscope system 2, a second endoscope system 3, and an air supply system. 4, a system controller 5, a monitor 6 that is a display device, a centralized display panel 7, a centralized operation panel 8, and a cart 9.

  Reference numeral 10 denotes a patient. Reference numeral 11 denotes an operating table on which a patient 10 lies. Reference numeral 12 denotes an electric knife device. An electric scalpel 13 as a surgical instrument is connected to the electric scalpel device 12. Reference numerals 14, 15, and 16 denote trocars that are punctured into the abdomen of the patient. The first trocar 14 is a trocar that guides an endoscope described later into the abdominal cavity. The second trocar 15 is a trocar that guides a treatment tool such as an electric knife 13 for performing excision and treatment of tissue into the abdominal cavity. The third trocar 16 is an abdominal gas supplied from an air supply device (described later) constituting the air supply system 4, for example, carbon dioxide gas (hereinafter referred to as carbon dioxide) that is easily absorbed by a living body. The trocar that leads to. Carbon dioxide gas may be guided from the first trocar 14 or the second trocar 15 into the abdominal cavity.

  The first endoscope system 2 is a first endoscope, for example, a rigid endoscope 21, which is also called a laparoscope having a rigid insertion portion, a first light source device 22, and a first camera control unit (hereinafter, referred to as a laparoscope). (Abbreviated as first CCU) 23 and an endoscope camera 24.

  An insertion portion (not shown) of the rigid endoscope 21 is inserted through the first trocar 14. An insertion optical system includes an observation optical system including a relay lens (not shown) that transmits a subject image, an illumination optical system including a light guide (not shown), and the like. An eyepiece 25 for observing an optical image transmitted by the observation optical system is provided at the base end of the insertion portion. An endoscope camera 24 is detachably disposed on the eyepiece 25. An imaging element (not shown) is provided in the endoscope camera 24.

  The first light source device 22 supplies illumination light to the rigid endoscope 21. The first CCU 23 converts an electrical signal formed and imaged on the image sensor of the endoscope camera 24 into a video signal, and outputs the video signal to, for example, the monitor 6 or the centralized display panel 7. As a result, an endoscopic image of the subject captured by the rigid endoscope 21 is displayed on the screen of the monitor 6 or the centralized display panel 7.

  Note that the rigid endoscope 21 and the first light source device 22 are connected by a light guide cable 26 that protrudes from the side of the proximal end portion of the rigid endoscope 21. The first CCU 23 and the endoscope camera 24 are connected by an imaging cable 27.

  The second endoscope system 3 includes an endoscope 31 having a flexible insertion portion 34 that is inserted into a lumen such as a large intestine, which is a second endoscope, a second light source device 32, and a second camera. A control unit (hereinafter abbreviated as second CCU) 33 is mainly configured.

  The endoscope 31 includes an insertion portion 34, an operation portion 35, and a universal cord 36. The operation unit 35 includes an air / water supply switch 35a and a suction switch 35b, a bending operation knob 37 for bending the bending portion (not shown), a treatment instrument insertion port 38 communicating with a treatment tool channel (not shown), and a pipe serving as a fluid supply base. A cavity air supply base 39 is provided. A light source connector 36 a and the like are provided at the base end portion of the universal cord 36.

  The second light source device 32 supplies illumination light to the endoscope 31. A light source connector 36a is detachably connected to the second light source device 32. By connecting the light source connector 36 a to the second light source device 32, illumination light is transmitted through a light guide fiber (not shown) and emitted from an illumination window provided at a distal end portion (not shown) of the insertion portion 34.

  The second CCU 33 converts an electric signal that has been imaged and photoelectrically converted into an image signal on an image sensor provided at a distal end (not shown) of the insertion portion 34 of the endoscope 31 into a video signal, for example, on the monitor 6 or the centralized display panel 7. The video signal is output. As a result, an endoscopic image of the subject captured by the endoscope 31 is displayed on the screen of the monitor 6 or the centralized display panel 7. Reference numeral 33a denotes an electrical cable that electrically connects the electrical connector 36b provided in the light source connector 36a and the second CCU 33.

  The air supply system 4 includes an air supply device 41, a gas cylinder 42 that is a carbon dioxide supply source, a foot switch 43 that is a lumen supply gas control switch, and a tube body for fluid, for example, an air supply tube 44a, 44b. The gas cylinder 42 stores carbon dioxide gas having a high pressure.

  The air supply device 41 includes an abdominal cavity supply base (hereinafter referred to as a first base) 41a that is a first supply base, and a lumen supply base (hereinafter referred to as a second base) that is a second supply base. 41b). One end of an abdominal tube 44 a that is a first tube is connected to the first base 41 a, and the other end of the abdominal tube 44 a is connected to the third trocar 16. One end of a lumen tube 44b, which is a second tube, is connected to the second base 41b, and the other end of the lumen tube 44b is connected to a lumen air supply base 39.

  The foot switch 43 outputs, for example, a carbon dioxide supply instruction signal for supplying carbon dioxide via the second base 41b to the controller described later when the switch 43a is being pressed by a foot. On the other hand, in a state where the foot is separated from the switch unit 43a, the carbon dioxide supply stop state is entered without outputting the carbon dioxide supply instruction signal to the control unit.

  The air supply device 41 and the gas cylinder 42 are connected by a high-pressure gas tube 46. The air supply device 41 and the foot switch 43 are electrically connected by a foot switch cable 43b. The tubes 44a and 44b are made of silicon or Teflon (registered trademark) having a small pipe resistance.

  The system controller 5 collectively controls the entire surgical system 1. The system controller 5 includes a central display panel 7 and a central operation panel 8, an electric scalpel device 12 that is an endoscope peripheral device, light source devices 22 and 32, CCUs 23 and 33, and an air supply device via a communication line (not shown). 41 and the like are connected so that bidirectional communication can be performed.

  An endoscopic image of a subject captured by the rigid endoscope 21 or the endoscope 31 is displayed on the screen of the monitor 6 in response to a video signal output from the first CCU 23 or the second CCU 33. .

  The central display panel 7 is provided with a display screen such as a liquid crystal display. Since the centralized display panel 7 is connected to the system controller 5, it is possible to centrally display the operation state of the endoscope peripheral device together with the endoscope image of the subject on the display screen.

  The central operation panel 8 includes a display unit such as a liquid crystal display and a touch sensor unit provided integrally on the display surface of the display unit. The display section of the centralized operation panel 8 has a display function for displaying operation switches and the like of each endoscope peripheral device as a setting screen, and an operation function for operating the operation switches by touching a predetermined area of the touch sensor section. is doing. Since the central operation panel 8 is connected to the system controller 5, by operating the touch sensor unit displayed on the display unit as appropriate, the operation switches provided in the respective endoscope peripheral devices are directly operated. In the same manner as described above, various operations or settings can be performed remotely on the centralized operation panel 8.

  The cart 9 includes a peripheral device such as an electric scalpel device 12, light source devices 22, 32, CCUs 23 and 33, and an air supply device 41, a system controller 5, a central display panel 7, a central operation panel 8, a gas cylinder 42, and the like. Is done.

Here, the configuration of the endoscope 31 will be described.
As shown in FIG. 2, a plurality of ducts 91, 92, 93, 94 described later are provided in the insertion portion 34, the operation portion 35, and the universal cord 36 of the endoscope 31. The operation unit 35 includes an air / water feed cylinder 95b in which an air / water feed button 95a constituting the air / water feed switch 35a is slidably disposed, and a suction button 96a constituting the suction switch 35b. A suction cylinder 96b that is slidably disposed is provided. Further, the light source connector 36a is provided with a suction base 36c, a water supply base 36d, and an air supply base 36e.

  The first conduit 91 is a suction conduit. The suction pipe 91 has a first suction channel 91a having one end communicating with a suction opening 34a provided at the distal end surface of the insertion portion 34 and the other end communicating with a suction cylinder 96b, and one end sucking. The second suction channel 91b communicates with the cylinder 96b and the other end communicates with the suction cap 36c. The other end portion of the treatment instrument channel 97 having one end communicating with the treatment instrument insertion port 38 communicates with the middle portion of the first suction channel 91a.

  The second pipeline 92 is an air supply pipeline. The air supply line 92 is connected to an air / water supply nozzle 34b provided on the distal end surface of the insertion portion 34, and one end thereof communicates with a predetermined portion of the air / water supply cylinder 95b. The air channel 92a includes a second air supply channel 92b having one end communicating with a predetermined portion of the air / water supply cylinder 95b and the other end communicating with the air supply base 36d.

  The third conduit 93 is a water supply conduit. The water supply pipe 93 has a first water supply channel 93a in which one end communicates with the middle part of the first air supply channel 92a and the other end communicates with a predetermined part of the air / water supply cylinder 95b. The second water supply channel 93b communicates with a predetermined portion of the air / water supply cylinder 95b and the other end communicates with a water supply base 36e provided in the light source connector 36a.

  The fourth pipe 94 is a fluid path that becomes a flow path for supplying carbon dioxide gas, for example. The fluid path 94 is configured by a fluid channel 94 a having one end communicating with the distal end opening 34 c of the insertion portion 34 and the other end communicating with the lumen air supply base 39. When the air supply pressure of the air supply device 41 is set to a predetermined pressure, for example, 50 mmHg, the fluid channel 94a has a pipe resistance that can at least obtain a predetermined flow rate, for example, 1 L / min or more. The inner diameter dimension is set on the inner surface, and the inner surface is subjected to a treatment such as coating.

  In addition, by applying a coating process or the like to the inner surface of the fluid channel 94a to reduce the pipe resistance, the inner diameter can be reduced to obtain a flow rate of 1 L / min or more.

Next, the configuration of the air supply device 41 will be described.
As shown in FIG. 3, a supply pressure sensor 51, a pressure reducer 52, an electropneumatic proportional valve 53, a first electromagnetic valve 54, a pressure sensor 55, a flow sensor 56, a switching valve 57, and a control unit 60 are included in the air supply device 41. It is mainly provided. The air supply device 41 is provided with a high pressure base 61, a switch connector 62, a setting operation section 63, and a display section 64 in addition to the bases 41a and 41b.

  The downstream side of the switching valve 57 branches into, for example, an A port and a B port, and is disposed on the upstream side of the caps 41a and 41b. The A port side of the switching valve 57 constitutes an abdominal flow path that is communicated with the abdominal tube 44a via the first base 41a and serves as a first conduit. On the other hand, the B port side of the switching valve 57 is connected to the lumen tube 44b via the second base 41b to form a lumen flow path serving as a second conduit.

  A high pressure gas tube 46 is connected to the high pressure base 61. A foot switch cable 43 b is connected to the switch connector 62. The switch connector 62 is connected to a control unit 60 which is a control means. Therefore, a control signal output from the foot switch 43 and instructing whether or not to supply carbon dioxide gas into the lumen is input to the control unit 60. The setting operation unit 63 and the display unit 64 are configured as a panel unit 65.

  The supply pressure sensor 51 measures the pressure of the carbon dioxide gas vaporized and supplied from the gas cylinder 42 and outputs the measurement result to the control unit 60. The decompressor 52 decompresses the carbon dioxide gas that has been vaporized and supplied into the air feeding device 41 via the high pressure base 61 to a predetermined pressure.

  The electropneumatic proportional valve 53 as supply means sets the air pressure to a range of approximately 0 to 50 mmHg based on the control signal output from the controller 60 with the carbon dioxide decompressed by the decompressor 52. The electromagnetic valve 54 is opened and closed based on a control signal output from the control unit 60. The pressure sensor 55 measures the intraperitoneal pressure or the intraluminal pressure and outputs the measurement result to the control unit 60. The flow sensor 56 measures the flow rate of carbon dioxide gas supplied to the caps 41 a and 41 b and outputs the measurement result to the control unit 60. Under the control of the control unit 60, the switching valve 57 is switched so that the carbon dioxide gas set to a predetermined pressure by the electropneumatic proportional valve 53 and passed through the flow sensor 56 flows into the abdominal channel or the lumen channel. .

  That is, the liquid carbon gas stored in the gas cylinder 42 is vaporized, sent into the air supply device 41 and decompressed by the decompressor 52, and then the abdominal cavity based on the control signal output from the control unit 60. It is supplied into the abdominal cavity through the use channel, or into the lumen through the lumen channel.

  Although not shown, an exhaust valve is provided between the electromagnetic valve 54 and the flow sensor 56. The exhaust valve is opened based on a control signal from the control unit 60 when the measured value of the pressure sensor 55 exceeds the intraperitoneal pressure set value. As a result, carbon dioxide in the abdominal cavity is released into the atmosphere, and the intra-abdominal pressure is reduced. Further, when the measured value of the pressure sensor 55 exceeds the intraluminal pressure set value, the open state is set based on the control signal from the control unit 60. As a result, carbon dioxide in the lumen is released into the atmosphere, and the pressure in the lumen is reduced.

As shown in FIG. 4, a panel portion 65 including a first base 41 a, a second base 41 b, a setting operation unit 63, and a display unit 64 is provided on one side of the air supply device 41.
The panel unit 65 includes a power switch 71, an air supply start button 72, an air supply stop button 73, intraperitoneal pressure setting buttons 74a and 74b which are setting operation units 63, an abdominal air supply gas flow rate setting buttons 75a and 75b, and a lumen. Side air supply gas flow rate setting buttons 81a and 81b, abdominal cavity mode changeover switch 82a, lumen mode changeover switch 83a, gas remaining amount display portion 76 as display portion 64, intraperitoneal pressure display portions 77a and 77b, abdominal flow rate display portion 78a and 78b, an air supply gas total amount display unit 79, intraluminal flow rate display units 80a and 80b, an abdominal cavity mode display unit 82b, a lumen mode display unit 83b, and the like are provided.

  The power switch 71 is a switch for switching the main power supply of the air supply device 41 to an on state or an off state. The air supply start button 72 is a button for instructing the start of supply of carbon dioxide gas to the abdominal cavity side. The air supply stop button 73 is a switch for instructing the supply of carbon dioxide gas to the abdominal cavity.

  The intra-abdominal pressure setting button 74a and the insufflation gas flow rate setting buttons 75a and 81a are changed in a direction of gradually increasing the set value by operating the buttons. On the other hand, the intraperitoneal pressure setting button 74b and the insufflation gas flow rate setting buttons 75b and 81b are changed in a direction of gradually lowering the set values by operating the buttons.

  The remaining gas amount display portion 76 displays the remaining amount of carbon dioxide in the gas cylinder 42. The measurement result of the abdominal pressure measured by the pressure sensor 55 is displayed on the intraabdominal pressure display section 77a. On the other hand, the set pressure set by, for example, operating the intra-abdominal pressure setting buttons 74a and 74b is displayed on the intra-abdominal pressure display section 77b.

  The measurement result measured by the flow sensor 56 is displayed on the abdominal flow rate display section 78a. On the other hand, the abdominal gas flow rate display section 78b displays a set flow rate set by operating the abdominal gas supply gas flow rate setting buttons 75a and 75b. The total gas supply amount display unit 79 displays the total amount of gas supplied by the CPU of the control unit 60 based on the measured value of the flow sensor 56.

  The lumen-side flow rate display unit 80a displays the measurement result measured by the flow rate sensor 56. On the other hand, the lumen-side flow rate display section 80b displays the set flow rate set by operating the lumen-side insufflation gas flow rate setting buttons 81a and 81b.

  The abdominal cavity mode changeover switch 82a instructs supply of carbon dioxide gas to the first base 41a, and the lumen mode changeover switch 83a instructs supply of carbon dioxide gas to the second base 41b. When the abdominal cavity mode changeover switch 82a is operated, the abdominal cavity mode display portion 82b is turned on. Similarly, when the lumen mode changeover switch 83a is operated, the lumen mode display portion 83b is turned on.

  The setting of the intraperitoneal pressure, the setting of the gas flow rate on the abdominal cavity side and the lumen side, and the like can also be performed by the concentrated operation panel 8. In addition, the operator designates in advance from the values displayed on the concentration display panel 7 on the intraperitoneal pressure display parts 77a and 77b, the flow rate display parts 78a, 78b, 80a and 80b, and the total gas supply amount display part 79. One or more values may be displayed.

The operation of the surgical operation system 1 having the second endoscope system 3 and the air supply system 4 configured as described above will be described.
In using the air supply device 41, an abdominal tube 44 a is prepared and connected to the first base 41 a and the third trocar 16. Also, a lumen tube 44b is prepared and connected to the second base 41b and the lumen air supply base 39.

  Next, the power switch 71 is turned on. Then, the pressure measured by the pressure sensor 55 is displayed on the intraperitoneal pressure display section 77a of the panel section 65. In addition, in the abdominal cavity pressure display section 77b and the flow rate display sections 78b and 80b, for example, the intra-abdominal pressure and the preset flow rate preset on the centralized operation panel 8 are displayed. Further, the remaining amount of carbon dioxide in the gas cylinder 42 is displayed on the gas remaining amount display portion 76, and the intraperitoneal pressure value is displayed on the intraperitoneal pressure display portion 77a.

  If the intraperitoneal pressure and the set flow rate are not set in advance, the intraperitoneal pressure is set by operating the intraperitoneal pressure setting buttons 74a and 74b and the insufflation gas flow rate setting buttons 75a, 75b, 81a and 81b. Set the flow rate.

  Thereafter, a predetermined amount of the third trocar 16 is inserted into a predetermined position of the abdomen. Then, in addition to the measurement result of the supply pressure sensor 51, the measurement result measured by the pressure sensor 55 is input to the control unit 60.

Next, the insertion portion 34 of the endoscope 31 is inserted from the anus to a predetermined site in the large intestine, for example.
Here, the abdominal cavity mode changeover switch 82a or the lumen mode changeover switch 83a is operated to select the air supply mode. At this time, when pneumothorax is performed, the abdominal cavity mode switching switch 82a is operated to turn on the abdominal cavity mode. Then, the lumen mode is automatically switched off. On the other hand, when supplying carbon dioxide gas to the lumen, the lumen mode switching switch 83a is operated to turn the lumen mode on. Then, the lumen mode is automatically switched off.

A control example when air is supplied to the abdominal cavity or lumen will be described with reference to FIG.
For example, when the insufflation start button 72 is operated in a state where the abdominal cavity mode is selected by the abdominal cavity mode changeover switch 82a, the control unit 60 determines whether or not the abdominal cavity mode is set as shown in step S1. If the control unit 60 determines that the abdominal cavity mode is selected, the process proceeds to step 2. Then, the control unit 60 outputs a control signal to the switching valve 57 to open the A port and configure the abdominal cavity flow path. As a result, the carbon dioxide gas supplied from the gas cylinder 42 through the high-pressure gas tube 46 into the air supply device 41 is decompressed to a predetermined pressure by the decompressor 52 and the electropneumatic proportional valve 53, and at a predetermined flow rate. After passing through the electromagnetic valve 54, it becomes possible to send it into the abdominal cavity via the first base 41 a, the abdominal tube 44 a and the third trocar 16.

  When supplying gas into the abdominal cavity through the first base 41a, a state in which the gas is supplied and a state in which the supply of the gas is stopped are repeated. Specifically, first, as shown in step S3, the control unit 60 detects the actual intra-abdominal pressure using the pressure sensor 55 and displays the intra-abdominal pressure on the intra-abdominal pressure display unit 77a. At the same time, the pressure reduction value of the electropneumatic proportional valve 53 is determined according to the difference between the set value displayed in the intraperitoneal pressure display section 77b and the intraabdominal pressure. Thereafter, the electropneumatic proportional valve 53 is opened after the electromagnetic valve 54 is opened, a gas having a predetermined pressure is supplied into the abdominal cavity for a predetermined time, and then the electromagnetic valve 54 is closed. By this series of operations, supply of gas into the abdominal cavity is realized.

  Further, in the state of supplying air to the abdominal cavity, the measurement result measured by the supply pressure sensor 51 and the flow rate sensor 56 is input to the control unit 60, whereby the gas remaining amount display unit 76 displays the gas remaining amount. The abdominal flow rate display section 78a displays the flow rate, and the total gas supply amount display section 79 displays the total amount of the gas supply gas determined by the calculation. On the other hand, in the air supply stop state, the measurement result measured by the pressure sensor 55 is input to the control unit 60, the intraabdominal pressure is displayed on the intraabdominal pressure display unit 77a, and as shown in step S4, the abdominal cavity is displayed. It is determined whether or not the internal pressure has reached a set value.

  In addition, in the state where it is determined by the control unit 60 that the abdominal cavity mode is set, the operation by the switch unit 43a of the foot switch 43 is disabled. That is, even when an instruction signal for starting air supply is input from the switch unit 43a to the control unit 60, the control unit 60 cancels the instruction signal.

  When the intra-abdominal pressure reaches a predetermined value near the set value displayed on the intra-abdominal pressure display section 77b in step S4, the A port of the switching valve 57 and the electromagnetic valve 54 are closed as shown in step S5. Then, the process proceeds to step S1.

  As a result, the pneumoperitoneum of the abdominal cavity is maintained in a predetermined state, and the treatment site is observed by the rigid endoscope 21 disposed on the first trocar 14 and the intraperitoneal cavity is observed via the second trocar 15. The inserted electric knife 13 can be used for treatment.

  When the measurement result from the pressure sensor 55 input to the control unit 60 becomes a predetermined value higher than the set value displayed on the intraperitoneal pressure display unit 77b, the control unit 60 exhausts the control signal. Output to the valve to open the exhaust valve. As a result, carbon dioxide in the abdominal cavity is released from the exhaust valve into the atmosphere, and the intra-abdominal pressure is reduced. At this time, together with the output of the control signal, the pressure warning lamp 85 may be blinked, for example, to notify the operator that the intra-abdominal pressure has become higher than the set value.

Next, the operation in the lumen mode will be described.
If it is determined in step S1 that the control unit 60 is not in the abdominal cavity mode, the process proceeds to step S6 to determine whether or not the lumen mode is in effect. Here, when an instruction signal for supplying carbon dioxide gas is not input from the switch unit 43a of the foot switch 43 to the control unit 60 to be described later, it is determined in this step S6 that the mode is not the lumen mode, and the process proceeds to step S1. To do.

  On the other hand, when the instruction signal from the switch unit 43a of the foot switch 43 is input to the control unit 60, it is determined in this step S6 that the lumen mode is selected, and the process proceeds to step 7. Here, a control signal is output from the control unit 60 to the switching valve 57, and the B port of the switching valve 57 is opened to configure the lumen flow path. As a result, the carbon dioxide gas supplied from the gas cylinder 42 through the high-pressure gas tube 46 into the air supply device 41 is decompressed to a predetermined pressure by the decompressor 52 and the electropneumatic proportional valve 53, and at a predetermined flow rate. After passing through the electromagnetic valve 54, the tube can be fed into the lumen through the second base 41b, the lumen tube 44b, the lumen air supply base 39, and the fluid channel 94a.

  When supplying gas into the abdominal cavity through the second base 41b, a state in which gas is supplied and a state in which supply of gas is stopped are repeated. Specifically, first, as shown in step S8, the control unit 60 detects the actual intraluminal pressure by the pressure sensor 55, and according to the difference between the preset set value and the intraluminal pressure, The pressure reduction value of the electropneumatic proportional valve 53 is determined. After that, the electropneumatic proportional valve 53 is opened after the electromagnetic valve 54 is opened, a gas having a predetermined pressure is supplied into the lumen for a predetermined time, and then the electromagnetic valve 54 is closed. By this series of operations, the supply of gas into the lumen is realized.

  In the air supply state to the lumen, the measurement results measured by the supply pressure sensor 51 and the flow rate sensor 56 are input to the control unit 60, while the pressure sensor 55 is input to the control unit 60 in the air supply stop state. As shown in step S9, it is determined whether or not the intraluminal pressure has reached the set value.

  When the controller 60 determines that the intraluminal pressure has reached a predetermined value in the vicinity of the set value, the B port of the switching valve 57 and the electromagnetic valve 54 are closed as shown in step S10, and step S1 is performed. Migrate to Here, when the inside of the lumen is in a desired swollen state, the treatment site is identified by performing observation with the endoscope 31 and observation with the rigid endoscope 21, and the electric scalpel 13 or the treatment instrument insertion port 38, treatment The treatment is performed by inserting the treatment instrument into the lumen through the instrument channel 97 and the first suction channel 91a.

  It should be noted that the measurement result measured by the supply pressure sensor 51 and the pressure sensor 55 is input to the control unit 60 in the state of supplying air to the lumen. As a result, the remaining gas amount is displayed on the gas remaining amount display unit 76, the flow rate is displayed on the lumen-side flow rate display unit 80a, and the supplied gas total amount display unit 79 calculates the supplied gas. The total amount of is displayed.

  In the state where carbon dioxide gas is being supplied to the lumen, the control unit 60 outputs a control signal as appropriate to the switching valve 57 to temporarily close the B port, while temporarily closing the A port. In the open state, the pressure sensor 55 detects the pressure in the abdominal cavity. That is, even in the lumen mode, the control unit 60 is constantly monitoring the intra-abdominal pressure.

  When the pressure in the abdominal cavity increases by a predetermined value or more from the set value during the air supply to the lumen, the control unit 60 performs control to open an exhaust valve (not shown). As a result, carbon dioxide in the abdominal cavity is released into the atmosphere, and the intra-abdominal pressure is reduced until it is close to the set value. When the intra-abdominal pressure reaches the vicinity of the set value, the control signal is output again to the switching valve 57 to close the A port, while the B port is opened to switch to the above-described air supply to the lumen.

  That is, the control unit 60 supplies carbon dioxide only from the first base 41a when the abdominal cavity mode changeover switch 82a is operated and the abdominal cavity mode is selected. At this time, when the switch unit 43a of the foot switch 43 is operated to be in the ON state, the control unit 60 performs control to cancel the instruction signal output from the switch unit 44a. On the other hand, when the lumen mode switching switch 83 a is operated and the lumen mode is selected, the control unit 60 supplies carbon dioxide only from the second base 41 b according to the operation of the foot switch 43. At this time, the control unit 60 constantly monitors the intra-abdominal pressure.

  As described above, the lumen air supply base is provided in the operation portion of the endoscope, and a fluid channel having one end communicating with the lumen air supply base and the other end communicating with the distal end opening is provided. Thus, the fluid path for supplying the gas into the lumen via the air supply device can be shortened, and the pipe resistance can be greatly reduced.

  Moreover, when the air supply pressure of the air supply device is a predetermined pressure, the output pressure used for the abdominal cavity is set to 0 to 50 mmHg by setting the pipe line resistance of the fluid channel so that a predetermined flow rate can be obtained. A gas supply device using an electropneumatic proportional valve that can be set within a range can supply gas into the lumen.

  And a second base for supplying gas to the lumen via a first mouthpiece for supplying gas to the abdominal cavity and a lumen air supply mouth for an endoscope having a fluid channel. And a switching valve communicating with each of the caps on the upstream side of the first cap and the second cap, thereby realizing air supply with low pressure to the abdominal cavity and the lumen. be able to.

  In this embodiment, the surgical operation system is configured by preparing an air supply device having a first base for supplying gas to the abdominal cavity and a second base for supplying gas to the lumen. In a surgical operation system using an endoscope having a fluid channel in an insertion portion, instead of using an air supply device provided with a first base and a second base, air is supplied at a low pressure. Two insufflation apparatuses may be prepared, and one insufflation apparatus may be used for the abdominal cavity and the other insufflation apparatus may be used for the lumen.

  In this embodiment, the foot switch cable 43b extending from the foot switch 43 is connected to the air supply device 41. However, the foot switch cable 43b is connected to the system controller 5 for control. Also good.

  Furthermore, in the present embodiment, a configuration is shown in which the foot switch 43 controls whether or not to supply air into the lumen, but for example, on / off control is performed electrically as shown in FIG. For this purpose, a hand switch 98 having at least one switch unit 98a for the operation may be detachably disposed on the operation unit 35 of the endoscope 31 as indicated by a broken line. Reference numeral 98 b is a fixing member having an attaching / detaching portion 98 c for fixing the hand switch 98 to the operation portion 35, and reference numeral 98 d is an extension signal cable from the hand switch 98. The signal cable 98d is electrically connected to the air supply device 41, for example.

  In the present embodiment, a configuration is shown in which the foot switch 43 controls whether or not to supply air into the lumen. However, for example, as shown in FIG. The endoscope 31 may be configured by providing an intraluminal air supply control switch 35c that electrically switches between an air supply state and an air supply stop state in the vicinity of 35a.

  Specifically, the intraluminal air supply control switch 35c outputs, for example, an electrical signal instructing air supply into the lumen to the control unit 60 when in the pushed state as shown by the solid line. On the other hand, when the intraluminal air supply control switch 35c is at the same height as the air supply / water supply switch 35a and the suction switch 35b as indicated by the broken line, the electric signal instructing the air supply into the lumen is controlled. It becomes the air supply stop position which is not output to the part 60.

  Further, in the present embodiment, a configuration is shown in which a lumen tube 44b is connected to the lumen air supply base 39 and gas is supplied into the lumen from the tip opening 34c via the fluid channel 94a. However, for example, a water supply tube extended from a water supply device (not shown) may be connected to the lumen air supply base 39 to supply water from the distal end opening 34c toward the front end surface of the insertion portion 34, or For example, a suction tube extended from a suction device (not shown) may be connected to the lumen air supply base 39 to suck the gas or the like in the lumen from the tip opening 34c.

  In this case, as shown in FIG. 8, instead of the intraluminal air supply control switch 35c that switches between the air supply state and the air supply stop state shown in FIG. Alternatively, an electric signal indicating the water supply stop state) is output, an electric signal indicating the air supply state (or water supply state) is output at the position indicated by the one-dot chain line, and an electric signal indicating the suction state is indicated at the position indicated by the solid line. By providing the output fluid control button 35d that can be switched in three stages, desired control can be performed by operating the fluid control button 35d.

  Furthermore, as shown in FIG. 9, for example, the treatment instrument insertion port 38 is provided with an adapter 47 having a tube connecting portion 47 a that is formed in a substantially cylindrical shape with an elastic resin member, and extends from the suction device to the tube connecting portion 47 a. The extracted suction tube 48 may be connected to constitute a surgical operation system. As a result, the fluid control button 35d can be operated by hand to supply gas into the lumen through the lumen flow path, while the fluid control button 35d can be operated by hand to operate the suction opening 34a and the first suction. Gas or the like can be sucked through the channel 91a, the treatment instrument channel 97, the treatment instrument insertion port 38, and the tube connecting portion 47a. Reference numeral 49 denotes a treatment instrument. The treatment instrument 49 passes through a treatment instrument insertion port 38, a treatment instrument channel 97, and a first suction channel 91a via a slit (not shown) provided in the adapter 47. Introduced into the lumen.

  According to this configuration, for example, when the surgeon determines that gas has been supplied more than necessary into the lumen, by performing a hand operation to move the fluid control button 35d to the solid line position, Gas can be sucked to forcibly reduce the intraluminal pressure.

  By the way, in an endoscope having an air supply / water supply conduit and a suction conduit in the insertion portion of the endoscope, when supplying carbon dioxide gas via the air / water supply conduit, it is provided, for example, in the light source connector 36a. Carbon dioxide is supplied to the air / water supply line through the air supply cap. For this reason, when the through-hole formed in the air / water supply button is in an open state, air is always leaked from the through-hole.

  In other words, in the configuration in which carbon dioxide gas is supplied into the lumen via the air supply base and the air / water supply conduit, the state in which carbon dioxide gas is supplied into the lumen, in other words, the air / water supply button Except for the state where the formed through hole is blocked, the carbon dioxide gas leaks from the through hole, and the carbon dioxide gas in the gas cylinder is wasted. In order to eliminate this problem, a suction part 35f having a suction hole 35e may be provided in the vicinity of the air / water supply switch 35a provided in the operation part 35 as shown in FIG. In the configuration described above, a hand switch 98 having the foot switch 43 or the switch unit 98a is used as a switch for controlling whether or not carbon dioxide gas is supplied into the lumen.

Thus, the carbon dioxide gas ejected from the through hole of the air / water feed switch 35a when the carbon dioxide gas is not supplied into the lumen is collected through the suction hole 35e of the suction part 35f. Can do.
In addition to the air / water supply conduit and the suction conduit, the endoscope is provided with an auxiliary water supply conduit that can supply water toward the front side of the distal end surface of the insertion portion, for example. is there. The pipe length of the auxiliary water supply pipe arranged in this endoscope is as long as that of the air supply / water supply pipe, but the pipe resistance is sufficient to supply water in the forward direction. It is smaller than the water pipe. Further, it is possible to switch between a water supply state and a water supply stop state by operating a sub-water supply switch provided in the operation unit.

  Therefore, a surgical operation system may be configured by combining an endoscope provided with a sub-water supply conduit and an air supply device. This makes it possible to use the auxiliary water supply pipe provided in the endoscope as a function of supplying air instead of the function of performing original water supply, without setting the gas supply pressure to a high pressure, In addition, the supply of carbon dioxide gas into the lumen can be controlled by operating the auxiliary water supply switch without preparing a foot switch or a hand switch.

  Note that the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

FIG. 1 is a diagram illustrating a configuration of a laparoscopic surgical system having first and second endoscope systems and an air supply system. The figure explaining the composition of the endoscope which provided various pipes The figure explaining the composition of an air supply device The figure explaining the panel part of an air supply apparatus The flowchart explaining an example of the air supply control by the control part of the air supply apparatus The figure explaining the hand switch detachably attached to the operation part of an endoscope The figure explaining the endoscope which provided the intraluminal air supply control switch in the operation part The figure explaining the operation state of a fluid control button The figure explaining the other structural example of the laparoscopic surgery system which can perform the air supply and suction to the lumen | bore The figure explaining the endoscope which provided the suction part near the air supply / water supply switch of the operation part In addition to the endoscope inserted into the abdominal cavity, a configuration example of a laparoscopic surgical operation system for performing a procedure for treating a treatment site by inserting an insertion portion of an endoscope into a lumen such as the large intestine will be described. Figure

Explanation of symbols

1 ... Laparoscopic surgical system
DESCRIPTION OF SYMBOLS 3 ... 2nd endoscope system 4 ... Air supply system 39 ... Luminous air supply base 41a ... Abdominal cavity supply base 41b ... Lumen supply base 53 ... Electropneumatic proportional valve 57 ... Switching valve 60 ... Control part 94 ... Fourth line 94a ... Fluid channel Agent Patent attorney Susumu Ito

Claims (6)

A universal cord that has a light source connector that can be connected to the light source device at one end and a light guide fiber that transmits illumination light from the light source device is extended to the insertion portion that is inserted into the lumen. An endoscope with a continuous operation unit,
A fluid supply base disposed in a portion different from the extension portion of the universal cord in the operation portion of the endoscope;
A carbon dioxide gas supply line for a lumen that is formed in the insertion portion of the endoscope without being connected to any fluid line in the universal cord, and that communicates with the fluid supply base;
Supplying a predetermined air pressure pneumoperitoneum for carbonated gas toward the inside the abdominal cavity through a trocar, which is pierce the abdominal wall according to the different abdominal cavity and the lumen in which the insertion portion of the endoscope is inserted And an air supply device capable of supplying the carbon dioxide gas for the lumen to the carbon dioxide gas supply line for the lumen in the endoscope with the same air supply pressure as the predetermined air supply pressure,
A first fluid tube body extending from the air supply device and connected to the trocar;
A second fluid tube body extending from the air supply device and connected to the fluid supply base disposed in a portion of the operation portion of the endoscope different from the extension portion of the universal cord. When,
Comprising
The lumen carbon dioxide gas supply line is supplied from the air supply device to the lumen carbon dioxide gas supply line via the second fluid tube body and the fluid supply base. The air supply pressure related to carbon dioxide gas is the same as the air supply pressure related to the carbon dioxide gas for insufflation supplied from the air supply device to the abdominal cavity through the first fluid tube body and the trocar. Even if it is a pressure, the carbon dioxide gas for a lumen more than a predetermined flow rate is supplied to the carbon dioxide supply pipe for the lumen against the abdominal pressure caused by the carbon dioxide for the pneumoperitone fed into the abdominal cavity. A laparoscopic surgical system characterized by having duct resistance. 2. The laparoscope according to claim 1, wherein the luminal carbon dioxide gas supply line has a line resistance capable of obtaining a flow rate of at least 1 L / min when the air supply pressure is set to 50 mmHg. Lower surgical system. The air supply device is
A first supply base to which the first fluid tube body connected to the trocar is connected;
A second supply base to which the second fluid tube body connected to the fluid supply base in the endoscope is connected;
A switching valve provided on the upstream side of the first supply base and the second supply base, for switching a plurality of flow paths;
The laparoscopic surgical system according to claim 1 or 2, further comprising: The endoscope is
On the operating unit, the state of stopping the supply of at least supplies a luminal cavity carbon dioxide through said fluid supply mouthpiece on the luminal cavity carbon dioxide supply line state or the luminal cavity carbon dioxide feed line The laparoscopic surgical system according to any one of claims 1 to 3, further comprising supply state selection means for selectively switching to the first to third.   The laparoscopic surgical system according to claim 4, wherein the supply state selection unit is an integrated switch provided integrally with the operation unit.   The laparoscopic surgical system according to claim 4, wherein the supply state selection unit is a detachable switch that is detachably provided on the operation unit.

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